<div class="form_container">
	<span id='statusMessageDemo' class='formAlertMsg'></span><br/>
	<table cellspacing="0" cellpadding="0" style='width: 100%;'>
		<tr>
			<td class='label'>
				{translate}Patient's ID{/translate}
			</td>
			<td>
				<input type="text" size="10" name="code" value="" id="code" onKeyUp="isReadyToSearch('demographicsSearchBtn');"/>
			</td>
			<td class='label'>{translate}Full name{/translate}</td>
			<td>
				<input type="text" size="30" name="name" value="" id="name" onKeyUp="isReadyToSearch('demographicsSearchBtn');"/>&nbsp;&nbsp;&nbsp;&nbsp;
				<span class='label'>{translate}Gender{/translate}&nbsp;&nbsp;</span>
				<input type="checkbox" id="male" name="male" value="male" onclick="reverse('female');isReadyToSearch('demographicsSearchBtn');"><span class='label'>{translate}Male{/translate}</span>
				<input type="checkbox" id="female" name="female" value="female" onclick="reverse('male');isReadyToSearch('demographicsSearchBtn');"><span class='label'>{translate}Female{/translate}</span>
			</td>
		</tr>
		<tr>
			<td class='label'>{translate}Date of birth{/translate}</td>
			<td>
				<input type="text" size="10" name="date" value="" id="date" onKeyUp="isReadyToSearch('demographicsSearchBtn');"/>
			</td>
			<td class='label'>{translate}Phone number{/translate}</td>	
			<td>	
				<input type="text" size="10" name="phone" value="" id="phone" onKeyUp="isReadyToSearch('demographicsSearchBtn');"/>&nbsp;&nbsp;
				<span class='label'>Email &nbsp;&nbsp;</span>
				<input type="text" size="20" name="email" value="" id="email" onKeyUp="isReadyToSearch('demographicsSearchBtn');"/>
			</td>
		</tr>
		<tr>
			<td class='label'>{translate}Address{/translate}</td>
			<td colspan='3'>
				<input type="text" size="30" name="street" value="" id="street" onKeyUp="isReadyToSearch('demographicsSearchBtn');"/>&nbsp;&nbsp;
				<span class='label'>{translate}Ward{/translate}&nbsp;&nbsp;</span>
				<input type="text" size="10" name="ward" value="" id="ward" onKeyUp="isReadyToSearch('demographicsSearchBtn');"/>&nbsp;&nbsp;
				<span class='label'>{translate}District{/translate}&nbsp;&nbsp;</span>
				<input type="text" size="10" name="district" value="" id="district" onKeyUp="isReadyToSearch('demographicsSearchBtn');"/>&nbsp;&nbsp;
				<span class='label'>{translate}Province/City{/translate}&nbsp;&nbsp;</span>
				<input type="text" size="10" name="province" value="" id="province" onKeyUp="isReadyToSearch('demographicsSearchBtn');"/>
			</td>
		</tr>
		<tr>
			<td colspan="4" align="right">
				<div id="demographicsSearchBtnDiv" class="buttonwrapper">
					<a id="demographicsSearchBtn" class='imgBtn' href="#"><img title='{translate}Search{/translate}' src="{$base_uri}/images/search.png"/></a>
				</div>
				<div id="loading" style="display:none;">
					<img src="{$base_uri}/images/ajax-loader.gif"/>
				</div>
			</td>
		</tr>
	</table>
</div>
<br/>
<div id='demoPaging' style="margin: 10px;display:none">
	{include file="main/element_paging_form.html"}
</div>
<div id="demographicsResult">

</div>